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PubMed2001

Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: what advice should we be giving?

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune oestrogen-mediated disease. Antiphospholipid syndrome (APS) is an autoimmune acquired thrombophilia. These two conditions may co-exist and are most frequently diagnosed in young women. Hormonal contraception may promote lupus activity and thromboses. Medical practitioners may not know what advice to give these women regarding contraception. OBJECTIVES: To determine the past and present contraceptive practices of women with SLE and/or APS, and to establish the incidence of complications related to use of various contraceptives. Also, the contraceptive information given to women following diagnosis was evaluated. STUDY DESIGN: Observational questionnaire-based study of 86 women with SLE and/or APS attending the Lupus/Thrombophilia Clinics at St. Thomas' Hospital. RESULTS: One of the 19 (5%) women with SLE using the combined oral contraceptive pill (COCP) at the time of diagnosis reported a severe lupus 'flare'. Seven of the 32 (22%) women with APS using the COCP suffered from thromboses during use. There were no problems specific to women with SLE and/or APS using any other form of contraception. Thirty-nine (45%) women received no contraceptive information following their diagnosis, 37 (46%) were told to avoid the COCP due to the increase in lupus 'flare' and/or thromboses. CONCLUSION: There is no clinically significant association between COCP use and lupus 'flare'. The high incidence of thromboses in women with APS using the COCP containing either second or third generation progestogens suggests that these women should be advised against using this form of contraception. Women with SLE and/or APS should be given more information about contraceptive issues.

Adolescent↗
PubMedDate not supplied

Effect of oral and injectable contraceptives on serum electrolytes, weight and blood pressure.

BACKGROUND: Since the introduction of oral and injectable contraceptives, many metabolic side effects have been reported. The use of oral contraceptive has been shown to be associated with increased level of serum electrolytes, but decrease in levels of serum electrolytes has been reported in women using injectable contraceptives. This study evaluated serum electrolytes, weight and blood pressure in women taking oral and injectable contraceptives because these changes have adverse effects on the health and economy of the subject. METHODS: Serum electrolytes, weight and blood pressure were measured in 50 women taking oral contraceptive (Lofeminal) and 50 women taking injectable contraceptives (Depomedroxy progesterone acetate and Norigest). The same women served as control before starting these contraceptives. RESULTS: There was a significant increase in serum sodium and chloride but significant decrease in serum potassium and bicarbonate level in women taking oral contraceptive. There was non-significant decrease in serum electrolytes in women taking injectable contraceptives. There was significant increase in weight and blood pressure of women taking these contraceptives.

Adult↗
PubMed2002

Experiences with Yasmin: the acceptability of a novel oral contraceptive and its effect on well-being.

There are well over 100 million women using oral contraceptives world-wide; however, the number of women taking the pill differs from country to country. In the 1960s when 'the pill' was launched, most women wanted an effective, reversible contraceptive method. In the twenty-first century, they take these properties of oral contraceptives as given and now expect a number of non-contraceptive benefits including lighter and less painful periods, 'clear skin' and an overall improvement in well-being. Many oral contraceptives fall short of this ideal, with women discontinuing their pills because of perceived side-effects including weight gain, mood changes and breast tension. A new oral contraceptive has been developed to help fill this need. It contains 3 mg drospirenone, a progestogen resembling endogenous progesterone, and 30 microg ethinylestradiol (DRSP/EE, Yasmin, Schering AG, Berlin, Germany). It has been shown to be highly effective in preventing pregnancies as well as providing good cycle control. Studies have suggested that rates of dysmenorrhea improved in women taking DRSP/EE as well as in women using an oral contraceptive containing 30 microg ethinylestradiol and desogestrel, but symptoms were more often mild or less often severe in the DRSP/EE group. Drospirenone is quite unique as it is derived from 17alpha-spirolactone and has antimineralocorticoid as well as antiandrogenic properties. The effect of DRSP/EE on skin has been evaluated in women with mild to moderate facial acne. A positive effect on acne and seborrhea was observed, with the median acne lesion count decreasing by 62.5% from baseline to cycle 9, whilst seborrhea decreased by 25.1%. Further areas of research are focusing on premenstrual symptoms. A very recent European study has been completed to assess the effect of DRSP/EE on the general well-being and fluid-related symptoms over six treatment cycles in women desiring contraception. Overall, these results suggest that women who report premenstrual symptoms, including psychological and/or somatic problems, before starting DRSP/EE, have improved scores when their Psychological General Well-Being Index is measured and suffer fewer somatic symptoms. In conclusion, the combination ofdrospirenone with ethinylestradiol provides an effective and well-tolerated oral contraceptive with positive effects on body weight, skin and premenstrual symptoms. These unique features of DRSP/EE may improve well-being and have a positive effect on oral contraceptive continuation.

Adolescent↗
PubMed2003

Observational study on the use of emergency contraception in Spain: results of a national survey.

The Consensus Statement on Emergency Contraception recommends the collection of data within each country in order to facilitate the use of emergency contraception; this has led us to design a prospective observational study with a view to identifying the reality in Spain regarding emergency contraception. We have conducted a national observational study including 4390 cases of requests for the prescription of emergency contraception in the entire Spanish territory, collected by means of a questionnaire completed by the person prescribing the emergency contraception between April and December 2002. The mean age of the women requesting emergency contraception was 23 years, with 35.1% of these being adolescents and 71% of them under the age of 24 years. Of the applicants, 40% reported that they were students and 31.8% were working. The educational level of studies was medium or higher. Emergency contraception had previously been used by 19.8% of the women and, of these, 75% used it on a single occasion. The main reason put forward for requesting emergency contraception was condom breakage (68.7%), followed by the failure to use any contraceptive measures whatsoever (15.4%). The Spanish women requesting emergency contraception are young students and resort to this method on one occasion.

Adolescent↗
PubMed2003

Postpartum contraceptive acceptance in León, Mexico: a multivariate analysis.

OBJECTIVES: The aim of the present study was to identify the reasons for the acceptance or rejection of contraceptive methods among postpartum women at the Hospital of Obstetrics and Gynecology in León, Mexico. METHODS: A prospective cross-sectional study of 1025 postpartum women was undertaken. Reasons for acceptance or refusal of contraceptives were registered in a written survey. Twelve sociodemographic variables were included as predictors in a logistic regression analysis; the acceptance or refusal was the dependent variable, and statistical significance was set at 0.05. RESULTS: There were 513 patients who accepted contraceptives (50.0%) and 512 (50.0%) who refused them. The main reasons for accepting contraceptives were definitive desire for no more children (17.0%) and satisfaction with previous contraceptive methods (21.5%). The main contraceptive methods chosen were intrauterine device (67.7%) and tubal sterilization (28.5%). Reasons for contraceptive refusal were husband's rejection (33.2%) and delaying contraceptive use until after finishing the postpartum period (31.8%). In the logistic regression model, the variables previous deliveries (p < 0.001), number of Cesarean sections (p < 0.001) and women's level of education (p < 0.02) were included as predictors of acceptance. CONCLUSIONS: Previous deliveries, previous Cesarean sections and women's level of education were significant in contraception acceptance. The rejection of contraceptives was mainly attributed to husbands.

Adolescent↗
PubMed2006

Ethinylestradiol + etonogestrel contraceptive vaginal ring: new drug. Possibly useful in some situations.

(1) The standard hormonal contraception consists of a combined oral contraceptive containing about 30 micrograms of ethinylestradiol and a well-evaluated and widely used progestin such as levonorgestrel or norethisterone. (2) A vaginal ring delivering about 120 micrograms of etonogestrel and 15 micrograms of ethinylestradiol daily for 3 consecutive weeks per cycle, which is then removed for one week, is now marketed in France as a contraceptive. Etonogestrel, a desogestrel metabolite, is classified as a 'third-generation' progestin. (3) On the basis of 2 non-comparative trials involving a total of 2322 women, the vaginal ring's contraceptive efficacy, as measured by the Pearl index, is about 1 per 100 woman-years, a value similar to that of other available combined hormonal contraceptives. (4) In total, 41% and 29.6% of women withdrew early from each of the two trials. In the two trials combined, 15.6% of women withdrew due to adverse events. (5) A comparative trial versus oral ethinylestradiol + levonorgestrel showed no difference in adherence rates, and similar Pearl index scores. (6) The most frequent adverse effects, occurring in about 20% of women using the vaginal ring, were gynecological disorders (vaginitis, leukorrhea or local discomfort). The other adverse effects were those common to all hormonal contraceptives. (7) The thromboembolic risk of etonogestrel, when administered in a contraceptive ring, has not been evaluated. (8) In practice, the standard hormonal contraceptive remains a combined oral contraceptive containing about 30 micrograms of ethinylestradiol plus a well-evaluated progestin such as levonorgestrel or norethisterone. The vaginal ring offers no advantage in terms of efficacy, adverse effects or adherence. However, it is an additional effective contraceptive and may be preferred by some women, at least temporarily, in certain situations.

Adolescent↗
PubMed1994

Attitudes and knowledge regarding contraception and prepregnancy counselling in insulin dependent diabetes.

AIMS: To assess knowledge and attitudes of women with insulin dependent diabetes to contraception, prepregnancy planning, and genetic risk. METHOD: Women with insulin dependent diabetes, aged 18 to 40, were identified from a population-based register of insulin users in North Canterbury. Participating subjects underwent a structured face to face interview, assessing current contraceptive practices and their knowledge and attitudes to the areas outlined above. RESULTS: One hundred and twenty four women, representing 86% of eligible women, agreed to participate. Eighty five subjects were using some form of contraception. The most popular choices were the combined oral contraceptive pill (35%), the progesterone only pill (12%), condoms (24%), vasectomy (12%) and tubal ligation (12%). All subjects recognised the importance of good blood glucose control during pregnancy. Thirty nine percent of subjects using contraception avoided the combined oral contraceptive pill because of concerns about metabolic and vascular side effects. Only 52% of subjects knew the correct figure for genetic risk of passing insulin dependent diabetes on to an offspring. CONCLUSIONS: Patient education regarding the need for prepregnancy planning in women with insulin dependent diabetes appeared adequate and the percentage of subjects using contraception was higher than that described in overseas diabetic populations. Over a third of subjects were however concerned about the risks of contraceptive options in insulin dependent diabetes, particularly with regard to the use of the combined oral contraceptive pill. This finding suggests that discussion about the advantages and disadvantages of contraceptive choices should be an integral part of patient education for women with insulin dependent diabetes mellitus of child-bearing age. Knowledge about genetic risk was inadequate in half the subjects interviewed, and this area of patient education could also be improved.

Adolescent↗
PubMed1983

Clinical experience with a triphasic oral contraceptive ('Trinordiol') in young women.

Seven hundred and fifty cycles of treatment with a new triphasic oral contraceptive (WL-49(50). 'Trinordiol') containing the lowest quantity of steroids of all available preparations were evaluated in 75 healthy young women (mean age 19.6 years), 70% of whom had regular, normal cycles. Sixty-five percent had not used contraception before; the others had previously been on combined or progestagen-only oral contraceptives or had an IUD. The mean length of treatment with the triphasic preparation was 10 cycles. No pregnancy was recorded during the 750 cycles of treatment. Fifteen (20%) women dropped out of the study for medical reasons, essentially breast tenderness, weight increase, spotting and nausea, in decreasing order of frequency. Mastalgia was present in 21% of the women (8.9% of the cycles) during triphasic oral contraception, but this symptom disappeared in more than half of the cases within 3 months of continued use. Other side-effects were less frequent: vaginal discharge (4.4% of the cycles), nausea (3.7%), abdominal and leg cramps (2.8%), headaches (3.2%) and weight increase (3%). Spotting and breakthrough bleeding were reported during only 1.9% of the cycles, a remarkably low frequency. No absence of withdrawal bleeding was noted. Weight and blood pressure changes were minimal and never reached statistical significance. Hypertension developed during triphasic medication in 1 predisposed individual. Complaints of oestrogen-related symptoms such as breast tenderness and digestive disorders were probably due to the reduced progestagen content of the preparation compared with combined low fixed daily dose oral contraceptives. However, no increases in dysmenorrhoea and/or premenstrual tension were noted. It is concluded that the triphasic preparation provides effective contraception with excellent cycle control and minimal side-effects, which should help to increase the acceptability of low-dose combined oral contraceptives.

Adolescent↗
PubMed1983

Oral contraceptives and breast cancer: final report of an epidemiological study.

During 1968-1980, 1176 women aged 16-50 years with newly diagnosed breast cancer and a like number of matched controls were interviewed at 9 teaching hospitals in London and Oxford and asked about their use of oral contraceptives. The results were reassuring. A few statistically significant differences in oral contraceptive use were found between the breast cancer and control groups, but the data were subdivided in many ways so that some "significant" differences would have been expected through the play of chance alone. Certainly no patterns of risk emerged which would suggest that any of the associations were causal. It must be stressed, however, that the data are still sparse in some important subcategories--for example, only small numbers of both cases and controls had prolonged oral contraceptive use before their first term pregnancy. For this reason, it is important that information on the possible relationship between pill use and breast cancer should continue to be collected. Women who had never used oral contraceptives presented with appreciably more advanced tumours than those who had been using oral contraceptives during the year before detection of cancer, while past users were in an intermediate position. These differences in staging were reflected in the pattern of survival. Possible explanations for these observations include "surveillance bias" among oral contraceptive users leading to earlier diagnosis and a beneficial biological effect of oral contraceptives on tumour growth and spread. Women with breast cancer reported never having used any method of contraception and heavy cigarette smoking (greater than or equal to 15 per day) significantly less often than controls. We could find no obvious explanation for the former observation, but suspect that the latter reflects the unrepresentative smoking habits of our hospital controls rather than a protective effect of smoking against breast cancer.

Adolescent↗
PubMedDate not supplied

[Treatment of diminished sexual response associated with the use of oral contraceptives (author's transl)].

Loss of libido associated with the use of oral contraceptives has been studied in 113 women of reproductive age who had taken a combined pill for periods ranging from 1 to 3 years. The patients were divided in four groups. In the first group (I) of 24 women oral contraceptive treatment was discontinued and all women received in intra-uterine contraceptive device (IUCD). The second group (II) of 36 patients, the brand of oral contraceptive was changed. Women in group (III) had their oral contraceptive maintained receiving in addition a mixture of an androgen and an estrogen (methyltestosterone 4 mg and ethynilestradiol 0.002 mg) daily. To women of group (IV) the oral contraceptive was discontinued but the androgen-estrogen mixture was given. All women in this group received an IUCD. Evaluation of the psyco-sexual parameters included changes in libido, time to reach an orgasm, duration and intensity or orgasms. Frequency of intercourse and response to autostimulation was also investigated. Libido was restored in 94.2% of patients in group II, in 97.3% of group III and in 92.8% of group IV. In group I only 55.6% of patients had libido fully restored. In view of the prompt restoration of libido in all groups except in patients discontinuing oral contraceptive therapy, it is suggested that loss of libido in oral contraceptive users has an important physological component which can be overcome probably by psychotherapy. Short term treatment with a mixture of methyltestosterone and ethynilestradiol seems to be highly effective in restoring libido in all patients.

Adolescent↗
PubMed1991

Contraceptive use and breast-feeding duration in rural Bangladesh.

The association between contraceptive use and breast-feeding duration was investigated in 2380 women in rural Bangladesh where women usually stop breast-feeding once pregnant. Life table analysis showed that women receiving regular injections of depo medroxy progesterone acetate (DMPA) and those using non-hormonal contraception breast-fed significantly longer than women using no contraception. In contrast, women using oral contraceptives (combination of 0.5 mg norgestrel and 0.05 mg ethinyl oestradiol) did not breast-feed longer than women using no contraception. It is suspected that prolongation of breast-feeding obtained by delaying the next pregnancy with this oral contraceptive was offset by the depressing effect of oestradiol on lactation. Thus, in communities where prolonged breast-feeding is associated with improved child survival, non-hormonal contraceptive methods, or injectable DMPA, should be preferred for lactating women to oestrogen-containing oral contraceptives.

Bangladesh↗
PubMed1996

Contraception in the 1990s.

Contraceptive technology has recently provided the market place with new barrier methods, new progestin oral contraceptives, an injectable contraceptive, the female condom, new male condoms, and the contraceptive implant. During the last decade, epidemiologists have clearly defined the non-contraceptive benefits of current contraceptive methods that include decreased infections, protection from various cancers, protection from many gynecologic problems that lead to surgery, as well as symptomatic relief from many gynecologic conditions. In conjunction with medical specialists, contraceptive researchers have established the increased safety and benefits of various contraceptive choices in women with medical conditions that, until recently, were contra-indications for their use. That these advances have occurred despite multiple legal and scientific assaults gives hope that the field will continue to grow.

Contraception↗
PubMed1991

Subdermal progestin implant contraception.

Sustained-release progestin contraceptives are a new approach to meeting a worldwide need for more effective and acceptable birth control. These contraceptive systems provide low, stable levels of synthetic progestins for periods of months to several years. Unlike earlier injectable and oral contraceptives, they do not cause peaks in progestin levels beyond those required for effective contraception, nor do they employ estrogens. For these reasons, sustained-release progestin systems are without some of the health risks attributed to birth control pills, and they are more effective, as well as easy to use, and completely reversible. They share common side effects, the most frequent of which is irregular menstrual bleeding caused by the erratic shedding of hypotrophic endometrium. Despite this and other minor side effects, most users find the sustained-release systems acceptable alternatives to other methods of contraception. Permanent or biodegradable subdermal implants, injections, intrauterine and intracervical devices, and vaginal rings are all employed as delivery systems for contraceptive progestins. The Norplant (Wyeth Ayerst, Radnor, PA) system, consisting of six silastic tubes filled with levonorgestrel and implanted under the skin, was recently approved by the US Food and Drug Administration and is already used by more than a half million women worldwide. The other sustained-release systems are in various stages of development, at least several years away from general use. When these new methods complete clinical trials, women will be able to choose from among implants, injections, or pellets with various durations of action, all providing convenient, highly effective contraception with low risk to health.

Biodegradation, Environmental↗
PubMed1995

Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching.

OBJECTIVE: Our purpose was to assess determinants of cervical ectopia and cervicitis, specifically after adjustment for cervical infection. STUDY DESIGN: A cross-sectional study was conducted with colposcopic, cytologic, and microbiologic examination of 764 randomly selected women attending a sexually transmitted disease clinic and 819 consecutive college students undergoing routine annual examination. RESULTS: After we controlled for potential confounders, cervical ectopia was positively associated with oral contraception and Chlamydia trachomatis infection and negatively associated with aging in both populations, with recent vaginal douching in patients with sexually transmitted diseases, and with current smoking in college students. Oral contraception wa also associated with the radius of ectopia, and among users of oral contraception ectopia was associated with duration of oral contraception. Cervicitis (evaluated by Gram stain, Papanicoloau smear, and colposcopy) was associated with cervical infection by C. trachomatis and cytomegalovirus (both populations) and with gonorrhea and cervical herpes simplex virus infection (patients with sexually transmitted diseases). Cervicitis was independently associated with ectopia but not with oral contraception after we adjusted for these four cervical infections. However, oral contraception was associated with edema and erythema of the zone of ectopia among women without cervical infection. CONCLUSIONS: Oral contraception, aging, cervical infection, smoking, and douching have effects on cervical ectopia that may influence the acquisition, transmission, or effects of sexually transmitted agents. Ectopia is associated with young age, oral contraception, and cervical infection; cervicitis is associated with ectopia and cervical infection by C. trachomatis, Neisseria gonorrhoeae, herpes simplex virus, and cytomegalovirus. In women without cervical infection, edema and erythema of the zone of ectopia are associated with oral contraception.

Adolescent↗
PubMed2005

Cervical cancer screening continues to limit provision of contraception.

PURPOSE: Balancing needs for contraception and cervical cancer screening is challenging for clinicians. We assessed US obstetrician/gynecologists' practices regarding requirement of Pap testing before prescribing oral contraceptive or emergency contraceptive pills. METHODS: Questionnaires structured as clinical vignettes describing women desiring contraception with different risks of cervical dysplasia were mailed to a national sample of 355 obstetrician/gynecologists. RESULTS: A minority (3%) of the 185 obstetrician/gynecologists who responded would refill 12 months of oral contraceptives without requiring Pap testing. However, most would provide a limited supply of oral contraceptives until Pap testing could be performed. A substantial proportion (11-16%) would refuse to prescribe emergency contraception to women who they felt required Pap testing. Younger physicians, those practicing in academic settings and those who follow American Cancer Society guidelines were more willing to prescribe contraceptives without Pap testing. CONCLUSIONS: Cervical cancer screening continues to limit prescription of routine and emergency contraception by many US obstetrician/gynecologists.

Contraception↗
PubMed1990

Contraception in the adolescent. Preparation for the 1990s.

An overview of current and future contraceptive methods available to the adolescent is presented. Emphasis is given to oral contraceptives, including low-dose monophasics and triphasics. Current research confirms the efficacy and safety or oral contraceptives for teenagers. Other methods are reviewed, such as the mini-pill, barrier contraceptives (including the cervical cap and female condom), injectable contraceptives, hormonal contraceptive implants, the vaginal ring, postcoital contraception, periodic abstinence, gossypol, and others. Though abstinence is the best contraceptive method for adolescents, contraceptive technology of the 1990s presents clinicians and sexually active youth with many additional options.

Adolescent↗
PubMed1999

Effect of price and access on contraceptive use.

The Family Planning Program in Bangladesh has been very successful. The contraceptive prevalence rate (CPR) has increased from 13% in 1979 to 49% in 1996. Now that the program has matured and demand for family planning has been created, the Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh is concerned with increasing its financial sustainability. Options to increase financial sustainability include cost sharing and a gradual transition from doorstep to static clinic delivery of contraceptives. Many of these alternatives would involve additional travel time or charges for consumers, and it is important to estimate the effect that these additional prices would have on the use of contraception. The effect of economic constraints, such as cash price and access to services on contraceptive method use, the choice of contraceptive method and provider choice, has been analyzed, taking into account the socioeconomic factors that influence decision-making for individual family members. Two data sources have been used for this analysis: (1) a survey on use of contraception and (2) two baseline surveys of 1993 and 1994 in the two field sites of the MCH-FP Extension Project (Rural) of International Center for Diarrhoeal Disease Research, Bangladesh. No effect of cash prices was found on the probability of use of any contraceptive method, but clients were to a limited extent responsive to price in making choices about contraceptive methods and providers. In addition, couples were less likely to use contraception or choose methods if the travel time to fixed clinics was greater than 30 min.

Adult↗
PubMed2001

Which contraceptive methods are recommended for young women with type 1 diabetes mellitus? A survey among gynaecologists in Greece.

BACKGROUND: Type 1 diabetes mellitus is common in Europeans. Optimal glucometabolic control at conception and during early pregnancy is necessary to reduce the risk of early miscarriage and congenital malformations. Safe and effective contraceptive methods are essential for these women in order to have a "planned pregnancy" under optimal conditions. AIM: To find out which recommendations Greek gynaecologists give to young patients with type 1 diabetes mellitus with respect to contraception. To regard the experience of Greek gynaecologists in counselling with women. To compare the Greek gynaecologists with German gynaecologists in a previously published similar survey. SUBJECTS AND METHODS: A structured questionnaire containing questions about attitude, health care and contraception in young women with type 1 diabetes was given to 400 Greek gynaecologists working in Athens. RESULTS: Only 70 (17.5%) of the Greek gynaecologists returned the questionnaire. Condoms were the preferred recommendation as contraceptive method for young women with diabetes mellitus type 1 in 64%. About 57% of the gynaecologists recommended this type of contraception as first line contraceptives for young women with diabetes type 1 who smoke. The two most important criteria for selection of a contraceptive method for Greek gynaecologists were the safety and the diabetes specific problems. The Greek gynaecologists had only limited experience in regard to counselling and treating young and adolescent women with type 1 diabetes. CONCLUSION: There was no consensus with respect to contraception among Greek gynaecologists. This is similar to our previous findings in a survey involving German gynaecologists. Practical experience in counselling and treating adolescent and young women with type 1 diabetes was limited among the gynaecologists who participated in this study. Working out proper recommendations for contraception crucial for optimal medical care for type 1 diabetic women in Europe.

Adolescent↗